A team of doctors in Boston has successfully operated on a fetus to treat a rare brain condition known as “vein of Galen malformation».

Although surgery on the uterus – performed before a baby is born – has been performed for other conditions, this particular operation was performed for the first time. Details of the procedure, which took place in March, were published in the journal Stroke on Thursday.

The condition occurs when the blood vessel that carries blood from the brain to the heart, also known as vein of Galen, is not developing properly. The dysplasia, known as VOGMresults in a huge amount of blood to press on the vein and heart and can lead to a number of health problems.

Terrible brain injuries and immediate heart failure after birth are the two big challenges“, he told CNN Dr. Darren Orbacha radiologist at Children’s Hospital Boston and an expert in the treatment of VOGM.

Typically, infants are treated after birth using a catheter to insert tiny coils to slow blood flow. However, according to Orbach, treatment often comes too late.

Despite advances in care, “50% to 60% of all babies with this condition are expected to get sick almost immediately. The bad thing is of the babies that get sick, there seems to be about a 40% mortality rateOrbach added. “About half of the infants who survive have severe neurological and cognitive problems“, concluded.

Faced with a choice

When they found out about their fourth pregnancy, Mr Derek and Kenyatta Coleman from Baton Rouge, Louisiana were surprised and excited. Kenyatta, 36, and Derek, 39, they have been married for seven years.

Kenyatta said nothing seemed to go wrong with the pregnancy. After having three children, Kenyatta thought of ultrasounds as routine appointment.

The baby was doing well. All her biophysical profiles were all normal”.

The Colemans even had a genetic test that labeled Kenyatta’s pregnancy as “low risk“, he said: “We honestly thought we were pretty good».

But when Kenyatta went for an ultrasound at 30 weeks pregnant, she was faced with something different. She remembers her doctor sitting her down and saying that worries.

“She shared with me that there was something wrong with the baby’s brain and also her heart was enlarged,” Kenyatta said.
After more research, there was diagnosis: VOGM.

The Colemans had learned of a clinical trial being conducted by the hospitals Brigham and Women’s and Boston Children’s and which could provide treatment to their baby, before it is born.

Kenyatta recalls being told about the potential risks — premature labor or brain bleeding for the fetus — but the Colemans felt there was no other option for them.

On March 15, exactly one month after ultrasound that detected the malformationKenyatta underwent surgery.

A procedure with two patients

For this surgery, there were two patients: Kenyatta and her baby.

The doctors had to make sure the fetus was facing up into the correct position, with his head against the mother’s abdominal wall.

Dr. Wilkins-Haug, director of Maternal Fetal Medicine and Reproductive Genetics at Brigham and Women’s Hospital, worked with Orbach to make sure the embryo was not only in the right place for the procedure, but that it would stay there.

Wilkins-Haug explained that once the fetus was in the optimal position, “he got a small dose of medicine so that it wouldn’t move and he also got a small injection of medicine for pain relief,” Wilkins-Haug said.

From there, doctors inserted a needle through the abdominal wall, carefully passing a catheter through the needle so that the tiny metal coils to fill the vein, slow the blood flow and reduce the pressure.

The baby showed signs of improvement immediately, with scans showing reduced blood pressure in key areas.

It was exciting at the time that we had technical success in doing the embolizationOrbach said.

But success was not only defined by that moment, but by what came next.

Will he be able to show continued progress after that? Will it just need additional support? Will he still suffer immediate heart failure?Kenyatta wondered.

Always a fighter

After the procedure, Kenyatta had a small leak of amniotic fluid. Two days later, the birth came at 34 weeks of pregnancy.

On March 17, Denver Coleman was born, weighing 4 kg and 30 grams.

I heard her cry for the first time and I can’t even put into words how I felt at that moment“, she remembers Kenyatta.

It was just, you know, the most beautiful moment to be able to hold her and look at her and then hear her cry».

Her doctors were also pleased. “In the immediate-neonatal period, she was very stable and did not need any of the treatments that are usually needed, whether it be coils or supporting her heart function with drugs“, she said Wilkins-Haug adding: “We believe that he will not need further treatment in the future, but even if he does, he will do very well».